Dr. Robert Murayama

On Nov. 3, the Asian Pacific Islanders Coalition on HIV/AIDS (APICHA) broke ground-literally and figuratively -with the opening of its Transgender Clinic. Often called one of the city's most progressive health centers because of their work with the LGBT community, APICHA's new clinic will provide comprehensive medical services for the transgender community, including hormone therapy and mental and social services. Dr. Robert Murayama, the head of APICHA's medical team, answered our questions about the challenges of opening the clinic and the shifting attitudes of the medical community toward transgender people.

How long have you been chief medical officer at APICHA?

I became chief medical officer three and half years ago, but I've been volunteering on and off at APICHA for the last 15 to 20 years. I've known for a long time that APICHA is an organization doing good and important things. It began as a grassroots advocacy organization and gradually grew to include prevention and then social services and eventually all medical care, with bilingual case management all along the way. It's a great honor and privilege as a physician to be able to push the envelope and promote the health needs of sexual minorities.

What's the most exciting aspect of opening APICHA's new Transgender Clinic?

That's a tough question. What's exciting is that we can think about how to solve a problem and then put the pieces together to solve it. There are such disparities in care for transgender and other sexual minorities. I grew up believing that access to health care was a basic human right, but there's a huge divide between the haves and the have nots. When you look at LGBT folks, they often don't have access to basic health rights. Forty-one percent of transgender people have attempted suicide; 20 percent of transgender people have been refused medical care. It's not right. And with APICHA's new Transgender Clinic, we can work to reverse those statistics. What's exciting is that we're the first transgender clinic in New York to promote health and wellness in primary care.

And what's the most challenging aspect of opening the new clinic?

Funding, no doubt. People always say there's a lot of money in health care, but that's not really the case when it comes to taking care of marginalized people on the fringes of society. Most funding for sexual minorities in the past has been based on HIV prevention. Transgender people have four times the infection rate of the general population. But HIV shouldn't be the entire issue. We're very lucky and grateful to have such a generous three-year grant from the Paul Rapoport Foundation to make the APICHA Transgender Clinic possible.

APICHA's Transgender Clinic is located Downtown, near the intersection of Broadway and Canal. Was there a specific reason to develop the clinic in the downtown neighborhood?

Yes, there was a very specific choice. APICHA has grown up around service to Asian and Pacific Islanders, as well as LGBT people and people of color who are HIV positive, so we wanted to be near our patient base. Because of our roots, we've always been in the Asian community. It makes a lot of sense for us to be here near so many underserved patient populations. Beyond that, the seeds of change in New York City are embedded here Downtown. The first immigrants to New York all those centuries ago started down on this end of the island, and today, 60 percent of Asians in New York City are recent immigrants. So, our new location is very "edgy"-we're right on the edge of Chinatown and Tribeca. It's ideal. At one point, APICHA was in Chelsea, but we found we needed to be closer to our patient base. So here we are.

How have you seen attitudes to transgender people change over the years of your involvement in the medical community?

In the medical community, they have changed tremendously. When I entered my residency, the guidelines we were following were very different than they are now. You had to essentially prove to the medical community that you were transgender. There were all sorts of strange barriers to appropriate care. It's one thing to not harm, but it's another to be ignorant and refuse to monitor folks. But the latest standards of care dictate that a physician's job is to see how he or she can help transgender people.

Our job is to help people through transition, to help them understand what to expect and to meet their needs-not to question their needs or ask them to prove their needs. So, in short, there have been significant changes to treatment and care of transgender patients, and here at APICHA, we're proud to be a part of that.

Transgender people can't be invisible in society any longer. People are finally paying attention, and we're paying attention by opening this clinic.